Provider Demographics
NPI:1942354360
Name:BELLEVIEW CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:BELLEVIEW CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-245-0145
Mailing Address - Street 1:11730 SE US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4560
Mailing Address - Country:US
Mailing Address - Phone:352-245-0145
Mailing Address - Fax:352-245-1512
Practice Address - Street 1:11730 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4560
Practice Address - Country:US
Practice Address - Phone:352-245-0145
Practice Address - Fax:352-245-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3146OtherMEDICARE GROUP
FL88211ZMedicare PIN